An A.D.H.D. marriage? It may sound like a punch line, but the idea that attention problems can take a toll on adult relationships is getting more attention from mental health experts. In a marriage, the common symptoms of the disorder — distraction, disorganization, forgetfulness — can easily be misinterpreted as laziness, selfishness, and a lack of love and concern.

Adults with attention disorders often learn coping skills to help them stay organized and focused at work, but experts say many of them struggle at home, where their tendency to become distracted is a constant source of conflict. Some research suggests that these adults are twice as likely to be divorced; another study found high levels of distress in 60 percent of marriages where one spouse had the disorder.

“Typically people don’t realize the A.D.H.D. is impacting their marriage because there’s been no talk about this at all,” said Melissa Orlov, author of the book “The A.D.H.D. Effect on Marriage,” to be published in September.

Ms. Orlov says she began studying attention deficit’s toll on relationships after her husband received the diagnosis about five years ago. Although she had been working for years with Dr. Ned Hallowell, a leading researcher on the subject, Ms. Orlov had not realized that the disorder was also ruining her marriage.

“I felt like he was consistently inconsistent,” she said in an interview. “I could never count on him. It goes from feeling responsible for everything to just chronic anger. I didn’t like the person I’d become either.” (They are now happily married, she added.)

Of course, complaints that a husband or wife is inconsiderate and inattentive, or doesn’t help enough around the house, are hardly limited to marriages in which one or both partners have attention problems. But A.D.H.D. can make matters much worse.

It can leave one spouse with 100 percent of the family responsibility, because the other spouse forgets to pick children up from school or pay bills on time. Partners without attention problems may feel ignored or unloved when their husband or wife becomes distracted — or, in another symptom of the disorder, hyperfocused on a work project or a computer game. They may feel they have no choice but to constantly nag to make sure things get done.

Spouses with attention deficit, meanwhile, are often unaware of their latest mistake, confused by their partner’s simmering anger. A lengthy to-do list or a messy house feels overwhelming to the A.D.H.D. brain, causing the person to retreat to a computer or a video game — further infuriating their spouse.

“It’s not because they’re lazy or they don’t love their spouse, but because they are distracted,” Ms. Orlov said. “But if you don’t know that distraction is the issue, you start to think the person doesn’t care about you, and anger and resentment build up.”

Although treatment often starts with medication, it typically doesn’t solve a couple’s problems. Talk therapy may be needed to unpack years of accumulated resentments. Behavioral therapy and coping strategies — for both partners — are essential; for instance, Ms. Orlov would banish long to-do lists in favor of recipe cards that each contain a single task, sorted in order of priority. It’s a subtle switch, she says, but surprisingly effective.

One of the biggest challenges is for both spouses to accept the very real toll an attention disorder can take. Often the partner without A.D.H.D. worries that the diagnosis will give the other partner an excuse for not helping; meanwhile, that partner typically has a hard time understanding how his or her behavior affects others.

“Initially I think I was a bit of a skeptic about A.D.D. in general,” said a 52-year-old man from Cleveland whose wife of 26 years recently received a diagnosis. He asked that his name not be used to protect the family’s privacy.

He described a life of “crushing responsibility,” of working full time, caring for his children and his wife, and maintaining the household and finances. “After years of this, I felt I didn’t have two children, I had three children and no one to help,” he said. “I was always the one who said, ‘No, we can’t do that,’ or ‘Get this done.’ I had to be sort of a nag.”

His wife’s distractedness was particularly challenging when the children were young. “She could be in the room but paying no attention to what was going on,” he said. Traditional counseling didn’t help. On the brink of the divorce, the wife found Ms. Orlov and Dr. Hallowell’s Web site, adhdmarriage.com, and began consulting with Ms. Orlov. Although the couple have only just started therapy, they are finally hopeful about their future together.

“It’s been a revelation,” the wife said. “I didn’t realize what a critical piece the A.D.H.D. has been in my marriage.”

A version of this article appeared in print on July 20, 2010, on page D5 of the New York edition of The Times.

“common symptoms of the disorder — distraction, disorganization, forgetfulness — can easily be misinterpreted as laziness, selfishness and a lack of love and concern.”

How do the professionals distinguish between the two? I have seen the toll laziness, selfishness, and (what I consider) pure passive-aggression have taken on a few of my close relationships.

People who routinely make you wait no less than 45 minutes, forget commitments, drag you along as they scramble to do things they should have completed days prior, etc.

Maybe some people are just lazy, selfish, and incapable of extending themselves. And I promise, once it gets to the point where the responsible and conscientous half of the relationship can no longer tolerate it, it’s usually become a passive-aggressive showdown and it’s high time you both walked away and cut your losses.

While doing some research on ADHD to try to understand what was happening with a nephew, I realized I was reading about my partner. It was a very helpful revelation. Instead of just seeing him as lazy, cold and unwilling to help plan ANYTHING, I finally understood. It has helped me totally change my tactics in dealing with him and, I think, saved our relationship.

“Long Day’s Journey into ADD” or
“The Young, The Restless and… What Were We Talking About”

— Honey, would you take out the garbage?
— Huh? What? Sure.
(10 min. later)
— What!! Why is the garbage still here? I thought you said you would take it out.
— Garbage? Whaa? I though you said you were “Going out to the garage.”
— Garage? What does the garage have to do with it?
— That’s what I say. Garbage, garage. WhatEVER.
— But seriously, someone needs to take out the garbage.
— What? Uhhh. Well if you are going to take it out… please put it back where you got it.
— HONESTYLY! :(( Could you PLEEEEEASE stop playing Pac-Man when I’m talking to you!
— I’m not playing. I’m working it. Besides, I’ve been doing other garbage all day.
— Look at me….LOOK AT ME!!!
— Shoot! I just got eaten by one of the blue ghosts. Can’t we talk about this later?
— Sometimes I wonder why I married you!
— Because I have a cute round head and eat dots?
— I think you have ADD! I think you should talk to a doctor!
— I thought you wanted me to take out the garbage…now the doctor? I’m confused.
— You are IMPOSSIBLE! You NEVER listen to ME?
— Whaaaat? Hold on just a sec…I’m about to get to another level.
— ARGH! I want a divorce!!
— Yeah-yeah…like I said, AFTER this level. You’ll be in the garage, right?

Meaningful relationships? Is there an app for that?
How about thinking of ADHD as the brain’s evolutionary response to the increasingly harried lives and insanely demanding schedules? The trend is going to escalate as our brain continues to be bombarded with 24/7 news cycles, sound bites, hundreds of emails, thousands of twitter feeds, scores of text messages from the cyber friends. While dealing with all this we are supposed to keep up with never-ending to-do lists and jam-packed personal calendars. It’s time we get back to basics and retrain the brain.

I’m looking forward to reading Orlov’s new book. I’ve had attention/distraction problems my whole life. I was the kid who was constantly staring out the window and daydreaming at school, and have always been horrible at keeping to routines, setting and following schedules, and meeting deadlines. But it wasn’t until this year, at the age of 39, that I finally decided to seek treatment for my ADHD, and this was in large part because of the trouble it has been causing in my marriage. We constantly fight about my inability to stick to a schedule, my poor housekeeping skills, my tendency to “zone out” when under a lot of stress, and especially my problems with money. I think ADHD takes an even greater toll on adult relationships when the wife is the one with ADHD, rather than the husband. As women, we’re supposed to be the ones who keep the household running smoothly, the ones who nag their husbands about not leaving stuff all over the place, etc. etc. Since I began taking Concerta a few months ago, it has definitely helped me to be more focused and get things done in a timely manner, but I can’t say it has really helped my relationship all that much. Fear we are heading for divorce…..

This article is enlightening, it makes me feel less alone in my struggle with my ADD and the problems it causes in my marriage. I wish more ADD people were aware of the impact their behavior has on others.

It feels awful to know that you are driving your beloved insane by your chronic inability to shred bills, make beds and file thank-you cards.
Coping strategies are a must! Otherwise, the house can quickly turn into a hoarder’s delight…

I have been fortunate to find a psychiatrist, Dr. Efrén Ramírez, who helps reorganize ADD families as family therapeutic communities. This process is easier when family members improve their diets with non-toxic chelated lithium, consumed in tiny amounts (micrograms). With the effect of chelated lilthium, couples begin to eliminate the stress described in your article and learn to communicate through therapeutic dialogue.

My husband, now ex-, was diagnosed ADHD about three years ago. We are now separated after thirty years. He was willing to take the drugs, but not so willing to do much more than acknowledge his diagnosis as a part of who he is. There was no recognition of the stresses put on me by his forgetful and distracted behavior, which most of the time felt like “not-love.” The detrimental effects of living in this environment for years take a great toll on the non-ADHD spouse and her self-esteem. I spent many years thinking that my requests were nagging, needy, and controlling because that was what was reflected back to me by the usually complete non-response. And I am talking about things like asking him to request two weeks off for a vacation that I would then plan, or asking to have a movie date in the evening that then would turn into a mad dash out the door as our plans became an afterthought. I always saw him as forgetful, and over the years, began to see myself as forgettable. The ADHD spouse has to be understanding about the unintended damage done; mine was angry and resentful that I felt unloved, especially after the diagnosis, when he thought all should be forgiven. Thanks for this article. I wish I had heard of this yearsago.

FROM TPP — This is heartbreaking but thanks for sharing what it’s like to be on the non ADD spouse. Obviously, as the story states, a diagnosis and medication is not enough. Both partners have to want to work together. I was very touched by this line of yours “I always saw him as forgetful, and over the years, began to see myself as forgettable.” I hope other partners with ADD read it and understand how their condition affects those closest to them.

Apparently, there is no such thing as laziness, selfishness, or people who are just bad people or fools, anymore.

What used to be simply anti-virtues, are now called “disorders” and treated with therapy and drugs. There are no bad people, just people with disorders that are not their fault. Don’t identify the bad behavior with the actor, because that would make them feel bad – instead, separate the bad behavior from the actor and tell them its not their fault, that they are a good person unfortunately afflicted with a disorder that causes them to behave badly.

So are there no bad people? No fools? No lazy people? The psychiatrists and psychologists would have us think so. This increases their business, because telling someone that they are simply a lazy fool is a sure way to make them not come back for more therapy at $100 an hour or more. I call this conflict of interest.

As someone with ADHD who has struggled with this exact issue in relationships, I can relate. This is a real thing, and finding ways to cope with it are important. It’s not about laziness, it’s about how your brain works. it’s not a matter of force of will. It’s hard to understand for someone who doesn’t struggle to keep “normal” tasks under control, the feeling of seeing your partner disappointed by your flightiness yet again, or that feeling of slipping behind at work on a long, boring project yet again.

Fortunately, one can take steps to address it.

And unlike what many of you have written, it’s not just about “popping a pill” and everything gets better. Medication can help, but it’s about making effective systems to organize your life, therapy, mediation, and working through a lot of conflicting mental patterns that you’ve had your whole life.

The couple mentioned in the article that makes recipe cards with single tasks is a good example of a non-medicated way for an ADHD person to get more done. It’s hard to explain to someone who’s brain works differently how something seemingly childlike is necessary for an ADHD person.

I’ve also thought about the “meeting society’s expectations” thing. Sure it’s true that someone with ADHD would probably not have a problem in daily life of a hunter-gatherer society, where stimulation is high every moment of one’s life, but the truth is that we live in the world we live in, and taking steps to meet our society half-way doesn’t mean you’re selling out.

Nowadays “professionals” think there is a cure for every social ill with a pill. Did any of the rest of you read that article several weeks ago, about giving women pills to increase their libidos, even if they were exhausted and stressed out from caring for the whole family? Geez louise.

Yes, a partner may have ADD to some degree of severity. One could theoretically argue that most of us do. But what about invoking the old-fashioned exercise of EXERTING oneself through discipline, so as not to be a drag on your loved ones and on society as a whole? Does mental will count for nothing anymore?

I am very wary of all these medical excuses for irresponsible behavior. Increasingly, we appear to be living in a society where we can’t accept blame or responsibility for anything anymore. The bad side of that is that we also decrease our power to do improve ourselves.

FROM TPP — This story isn’t about taking a pill to solve a problem — in fact it specifically states that pills alone won’t help a marriage plagued by the complications of ADHD. The goal here is to understand the behavior and find ways to address it so that the person who suffers from distraction can learn how to be more reliable and take part in family life. It’s not about letting anybody off the hook or giving them an excuse. It gives them an explanation so that both spouses can understand the behavior and hopefully work together to find ways to address it.

Based on some of the previous posts, one can easily understand why Congress felt it necessary to pass mental health parity legislation.

Mental health issues (including ADD/ADHD) are just as real as physical health issues. There are pretty clear clinical criteria for diagnosing these, and a number of treatments which has been shown to be effective in helping restore the lives of affected individuals to some sense of normalcy.

Now if we could only address the biases and stigmas that at least a portion of society holds regarding such disorders.

#3 ca: were you in MY garage?? I swear you were eavesdropping at my house last week. No one can truly understand what it is like to live with someone like this, day in and day out. Add non-native English speaker with a hearing deficiency, and the daily charade becomes even more comical. And frustrating. And sad.

You can tell, reading these comments, who has really and truly dealt with ADHD and who has not.

No, it is not simply a matter being passive aggressive. No, it is not just a disease of modern life, or we would all have it. No, it is not because some people are just lazy fools. Yes, #7, it feels awful.

My husband has severe ADHD. Yes, he is passive aggressive, distractible, and lazy – but there is nothing in it for him. He is not being manipulative; he just can’t get anything right – and I do mean anything. He can’t maintain a job or career. He is subject to my fury and frustration at every turn, every day. Our kids live in horror of turning out like him. He regularly makes catastrophic mistakes, to the point where it is better not to let him have any responsibilities for anything. But what kind of a life is that? What adult spouse would WANT to be constantly demeaned and infanticized?

I think there is a dividing line between bad behavior and ADHD. People behaving badly still manage to look out for themselves and get what they want. People with ADHD don’t and can’t.

As a married adult repeatedly diagnosed with ADD, I can tell you it can indeed be hard on a spouse — it’s hard on my wife.

I can also tell you it is real, although I personally do not think ADD is pathological (an illness), but rather a personality type, and one that is on a continuum (there is a wide spectrum of how easily distracted or disorganized a person can be; nearly everyone is, of course, distracted from time to time).

Nonetheless, a personality type that can be easily overwhelmed by the responsibilities of the information age.

It is not an excuse for a failure to fulfill one’s adult responsibilities. Except for the most severe instances, most ADD adults are smart and capable, and do best in structured environments (whether structured by themselves or others).

ADD is also not necessarily a liability. Most ADD types have the ability to think on several levels at a time and see connections others don’t see. They are often capable of hyperfocussing on a particular matter, and pursuing it relentlessly. So there is a trade-off in this personality type.

But the ADD “label” at least allows other people to understand that some personalities have more difficulty than others in managing time and attention in an era of information overload.

Perhaps someday, we will have a psychology that understands the full range of human personalities better — with less focus on alleged pathology (partly fueled by insurance requirements), and more focus on what the talents of various types are likely to be, and in what environments they are likely to thrive.

Oh…….is that what has been wrong with men all these eons? Is that why they don’t shoulder any responsibilities with regard to the kids (i.e., do not make any appointments with the pediatrician, teachers, other parents for playdates or accompany them to any appointments, help with homework, cleaning up, meals, talks, storytelling, tucking in a bedtime, disciplining, problem solving), household cleaning, laundry, straightening up, arranging for or making large and small repairs, arranging and coordinating family entertaining with the neighbors, for birthdays and holidays, paying bills, doing the marketing, and so on. Mystery solved! They’re sick! Now we know why American women are breaking down from all their responsibilities – their husbands have ADHD! Whew!

I love the comments that doubt the realities of ADD/HD. People speaking out their you know whats without any clue. First marriage ended in divorce. Went onto Concerta — second marriage working for years. No one except someone with ADD/HD or an expert in the field can really understand the feelings of being out of control and bombarded with thoughts from every direction simultaneously and then not being aware that its happening until you lose your temper and/or get treatment.

Actually, if one is fortunate enough to be in an accepting relationship, perhaps with a partner who has the same condition, and if the hectic disorderliness of it all isn’t too onerous, and if there’s love and humor, it’s not so much a “disorder” as a very zestful way of life!

We should remember that there’s a very, very broad spectrum of human behaviors and life styles.

I don’t know what causes it, but ADHD is real. And people with bipolar disorder often have it, as well. I don’t know if there was a name for it prior to the modern age of pharma, but I’ve seen it, generationally, in my husband’s family. Maybe we didn’t need a name for it, because in agrarian times, folks with attention span disorders weren’t required to interact with others in the manner that we must, in this “service economy.” Maybe they were called ‘simple’ and left to their own.
My sweetie has the attention span of a gnat and had 5 children because of it or in spite of it, not sure. Now several of his children are also expressing this trait. His sister has been treated with Adderal for years, but medication is inappropriate for my husb, as it exacerbates his bipolar. I believe that my husband’s mother also probably has some symptoms, as well. In each case, it has contributed to inadequate parenting to some degree.
This has been compounded for my husband’s own children due to his ex-wife’s ADHD as well. I have often wondered how they managed together, but I can tell from their non-ADHD children, that routine and stability sorely lacked. ADHD has definitely been known to be heritable. Not many hypochondriac families all with ADHD, I think. They also all experience synesthesia or other sensory integration disorders (about the existence of which I was doubtful at first).
There are also lifestyle choices that we can make, that contribute to a healthier attention span. My husband takes nutritional supplements, we have changed our diet to fewer processed foods and more whole grains and fruits, and literally unplugged the TV. (Still have to have the computer…) It’s unfortunate that only adults with ADHD have these choices. Children don’t.
People with ADHD would be better served by the world if we changed our understanding of this issue. It’s neurobiologically originated executive dysfunction. It can be made better (as your whole body can- but not cured) with better nutrition. ADHD children, with attentive and consistent parenting, can be exposed to stimulus and taught coping mechanisms such as exercising vigorously to assist them to better function in the world. Some people with ADHD need meds. Some don’t. But please oh please don’t claim that it doesn’t exist and that people with ADHD don’t have impaired lives because of it.